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INDIAN JOURNAL OF APPLIED RESEARCH X 615 Volume : 6 | Issue : 4 | April 2016 | ISSN - 2249-555X | IF : 3.919 | IC Value : 74.50 RESEARCH PAPER Provisional Rehabilitation of The Cleft Lip And Palate – A Case Report Nazish Baig Babita Yeshwante MDS ,Professor , Department of Prosthodontics and Crown & Bridge, CSMSS Dental College &Hospital , Aurangabad. MDS, Professor and Head of the Department, Department of Prosthodontics and Crown & Bridge ,CSMSS Dental college & Hospital, Aurangabad. * Nikita Parasrampuria Gaurav Tated 2nd year M.D.S. Post graduate Student, Department of Prosthodontics and Crown & Bridge, CSMSS Dental College &Hospital , Aurangabad. * CORRESPONDING AUTHOR 2nd year MDS Post graduate student , Department of orthodontics and dentofacial orthopaedics, CSMSS Dental college & Hospital, Aurangabad. Medical Science KEYWORDS Colonclassification, PHP. Introduction Orofacial clefts are one the most common congenital cran- iofacial malformations which affect children. This anomaly of the middle third of the face is characterized by the pres- ence of oronasal communication, malformation or agenesis of teeth close to the cleft and deficient saggital and trans- verse growth of maxilla 1 . Many etiological factors, varying from mutation of genes, chromosomal aberrations or integration of genetic and en- vironmental agents contribute to the development of the same. The goal of maxillofacial rehabilitation is not only esthetic and functional but it should also allow for the rein- tegration of the patient, back into the society with a raised self esteem and confidence. The key to successful treat- ment is the management of the patient via the multidisci- plinary approach. Provisional restorations are essential in prosthodontic ther- apy 2 . Although a definitive restoration may be forthcom- ing, a provisional restoration must satisfy important clinical requirements for both the patient and the dentist 3 . After orthodontic treatment, the proper tooth and arch re- lationship must be maintained while the treatment results are being refined for a patient who has a cleft lip and pal- ate 1 . A conservative alternative treatment could be con- ventional fixed or removable prostheses for patients who refuse surgical intervention 4. For many patients who have cleft palates removable partial denture often is the restora- tion of choice 5. The Article describes the rehabilitation of a patient with cleft lip and palate with a provisional modified removable partial denture like an obturator. Case Report Patient Evaluation A 16 year old girl, born with cleft lip and palate, seeking prosthetic evaluation, reported to the department of Pros- thodontics and Crown & Bridge, post orthodontic treat- ment. She underwent cheiloplasty at 7 months of age and palatoplasty at the age of 2 years. Clinical examination of the patient revealed poor oral hygiene .She presented with an inadequately repaired unilateral cleft lip and palate, on the left side with related psychosocial problems[Fig : 1]. Intraoral examination revealed a congenitally missing lat- eral incisor, with the cleft extending upto one third of the anterior 2/3rds of the hard palate. The central incisor adjacent to the site of the cleft, exhib- ited Grade 1 Mobility. Localized gingival inflammation was observed after gentle probing with respect to the teeth adjacent to the cleft site. Radiographic analysis revealed inadequate alveolar bone and slight widening of the periodontal ligament space with respect to the mesial aspect of the canine. Treatment Considerations Prior to the initiation of treatment, all the several options were discussed and explained to the patient and the guardians. They were informed about all the clinical find- ings, and were given thorough explanation of the advan- tages and disadvantages of treatment with a modified removable partial denture. An informed consent was ob- tained for the same. Prosthesis Design The prosthetic considerations for the appliance fabrication included: • Age of the patient • Retentive orthodontic phase – 6-9 months post treat- ment • Bone availability at the defect site • Maintenance of periodontal health after replacement of the missing lateral incisor. Clinical procedures Preliminary Maxillary and mandibular complete-arch im- pressions were made using irreversible hydrocolloid im- pression material .Another impression of the complete maxillary arch (including the defect ) was made in poly vinyl Sloane.[Fig:2]. Diagnostic casts were fabricated from Type IV dental stone. The temporary denture base was fabricated with auto polymerized clear acrylic resin. The ar- tificial teeth were arranged in wax for trial evaluation along with the Hawley’s retainer (labial bow and Adams clasp)
